This application is a competitive renewal of a K24 grant awarded to the applicant for the period of 09/2002 to 08/2008. The main goals of this grant proposal are: (a) to develop a comprehensive patient-oriented research portfolio in areas of chronic kidney disease and kidney transplantation;and (b) to mentor nephrology trainees in patient-oriented research (POR). Progress Report: The current K24 award enabled the applicant to devote significant effort to several clinical research projects and to provide mentorship to seven trainees. These award-related activities have resulted in 25 peer-reviewed publications including nine first author and five senior author manuscripts. Specific Aims: Three specific aims will be undertaken. Aim 1 is to continue two ongoing independently funded research projects namely: (a) The Chronic Renal Insufficiency Cohort Study (CRIC);and (b) The Sirolimus-based, Steroid Avoidance Immunosuppression in Black de novo Kidney Transplant Recipients. Aim 2 is to initiate two new research projects namely: (a) The Epidemiology and Clinical Outcomes of CKD Patients with Chronic Hepatitis C (HCV) Infection;and (b) The Prevention of Kidney Disease in Liver Transplantation. Aim 3 is to provide mentorship in POR to Dr. Fu Luan and Dr. Silas Norman (both are at the level of Assistant Professor of Medicine) and two new trainees. Methods: In the first new research project, the applicant will study the prevalence, incidence, risk factors, renal and cardiovascular outcomes associated HCV infection in pre-ESRD CKD subjects. In the second new project, 130 de novo liver transplant recipients will be randomized into two different initial immunosuppressive regimen to evaluate the safety and efficacy of 14-day delayed introduction of calcineurin inhibitor therapy. During the period of mentorship, Dr. Luan will obtain an MSc degree, submit a R01 grant application and complete his own research project on the "Genetic Predisposition to Abnormal Glucose Metabolism in Kidney Transplant Recipients". Mutatis mutandis, Dr. Norman will obtain an MPH degree, submit a K23 grant application and complete his own research project on "Preventing Outcomes Through Effective Cardiovascular Risk Reduction after Transplant". Significance: An uninterrupted K24 funding is needed to maintain a limited clinical workload so that the applicant can continue to mentor trainees in POR and be able to conduct high quality clinical research. PUBLIC HEALTH RELEVANCE: Manpower analysis indicates a nascent shortage of nephrologists devoted to clinical and translational research. One of the ways to minimize the manpower shortage is to support the training of nephrologists in patient-oriented research.